In the Book of Numbers (11:31-35) the Old Testament refers to a plague suffered by the Israelites during their exodus from Egypt.
It happened after they ate quail.
Something strange occasionally happens in the Mediterranean region to people who eat quail, often in the Spring.
It happened after they ate quail.
Something strange occasionally happens in the Mediterranean region to people who eat quail, often in the Spring.
Cory doesn’t care about quail, or plagues, or the Mediterranean.
It’s almost summertime, and Cory has Major Plans involving staying with some (very attractive) friends at a beach house.
All he cares about right now is getting in shape.
Fast. 2/
It’s almost summertime, and Cory has Major Plans involving staying with some (very attractive) friends at a beach house.
All he cares about right now is getting in shape.
Fast. 2/
He hasn’t exercised strenuously in a very, very long time. No matter. He won’t let it dissuade him.
He has borrowed dumbbells and a jump rope and a video to watch.
His living room is warm, as sunlight streams in through the many windows.
He’s sweaty before he even starts. 3/
He has borrowed dumbbells and a jump rope and a video to watch.
His living room is warm, as sunlight streams in through the many windows.
He’s sweaty before he even starts. 3/
As he begins his exercise routine, his muscles complain almost immediately and he is quickly short of breath.
But then he thinks of all the beautiful people he is hoping to mingle with, and doubles down.
Pain is all in your mind, right?
Time to push through. 4/
But then he thinks of all the beautiful people he is hoping to mingle with, and doubles down.
Pain is all in your mind, right?
Time to push through. 4/
The video he is watching came with all sorts of warnings. Cory has never been one for warnings. He skips the recommended rest breaks and goes straight to the heaviest weights.
And he only allows himself a gulp or two of water in between sessions.
He feels tough.
Spartan. /5
And he only allows himself a gulp or two of water in between sessions.
He feels tough.
Spartan. /5
After several hours have elapsed, he is feeling light-headed. He turns off the TV and wobbles over to the couch. Drinking a bottle of Gatorade, he sighs deeply, feeling his muscles scream.
He is satisfied. Job well done.
What he doesn’t know is that he is in mortal danger. 6/
He is satisfied. Job well done.
What he doesn’t know is that he is in mortal danger. 6/
Cory’s muscles, unused to any exercise at all, have been pushed way past their limits.
In an environment that rapidly dehydrated and overheated him, his muscle cells have started to rupture and die, spilling their contents into his blood.
He closes his eyes to take a nap. 7/
In an environment that rapidly dehydrated and overheated him, his muscle cells have started to rupture and die, spilling their contents into his blood.
He closes his eyes to take a nap. 7/
While Cory naps, his kidneys are fighting a deadly battle.
Blood levels of numerous chemicals and metabolites are rising dangerously high, and his kidneys are unable to maintain the balance.
Overwhelmed, they desperately try to excrete the potassium from the dead muscle... 8/
Blood levels of numerous chemicals and metabolites are rising dangerously high, and his kidneys are unable to maintain the balance.
Overwhelmed, they desperately try to excrete the potassium from the dead muscle... 8/
Cory wakes up much later and realizes his pain is even worse. Aching, cramping all over.
“Holy sh-,” he says, and fumbles for the Gatorade but spills it on the floor. He gets up slowly, feeling feverish.
Limping to the bathroom, he pees a tiny amount.
It’s dark brown. 9/
“Holy sh-,” he says, and fumbles for the Gatorade but spills it on the floor. He gets up slowly, feeling feverish.
Limping to the bathroom, he pees a tiny amount.
It’s dark brown. 9/
He has a critical choice to make here.
If he chooses to try and sleep it off, he will be in multi-organ failure by dawn, and likely close to death.
If he dials 911 or goes to the hospital, the situation is still salvageable.
Reaching for a sleeping pill, he limps to bed. 10/
If he chooses to try and sleep it off, he will be in multi-organ failure by dawn, and likely close to death.
If he dials 911 or goes to the hospital, the situation is still salvageable.
Reaching for a sleeping pill, he limps to bed. 10/
Sitting on the edge of the bed he feels strange waves of warmth and numbness ripple through his larger muscles. Nausea rears its ugly head.
His phone rings.
It’s his friend, Matt.
Matt is an experienced fitness buff and loaned him the workout gear.
Matt could save him. 11/
His phone rings.
It’s his friend, Matt.
Matt is an experienced fitness buff and loaned him the workout gear.
Matt could save him. 11/
Matt knows what the signs and symptoms of rhabdomyolysis are. As he listens to Cory, his heart sinks. He tells him to wait right there, he’s on his way.
Later that night they’re in the hospital.
Cory has received large volumes of IV fluids, but he isn’t peeing.
At all. 12/
Later that night they’re in the hospital.
Cory has received large volumes of IV fluids, but he isn’t peeing.
At all. 12/
Rhabdomyolysis is a syndrome characterized by muscle death and release of the muscle cellular contents into the blood. The myoglobin from the dead muscle can cause kidney failure.
Cory is started on dialysis to help lower his potassium and clear the muscle enzymes. 13/
Cory is started on dialysis to help lower his potassium and clear the muscle enzymes. 13/
Another complication of rhabdomyolysis is something known as “compartment syndrome.” When the swelling and edema in a limb or enclosed space can threaten to kill off even more tissue.
Cory’s legs are red, and swollen, but he doesn’t need surgery to open them up.
Not yet. 14/
Cory’s legs are red, and swollen, but he doesn’t need surgery to open them up.
Not yet. 14/
Thankfully with several days of critical care in the intensive care unit, including special fluids, medications, and dialysis, Cory is doing much better.
He will lose a significant amount of muscle mass and has a lengthy rehabilitation process ahead of him.
But he’s alive. 15/
He will lose a significant amount of muscle mass and has a lengthy rehabilitation process ahead of him.
But he’s alive. 15/
In the Spring, migrating quail in the Mediterranean region consume hemlock herbs.
Hemlock is a known cause of rhabdomyolysis, and eating quail has been shown to trigger it.
Indirect evidence suggests the plague described in The Book of Numbers happened in the Spring. /16
Hemlock is a known cause of rhabdomyolysis, and eating quail has been shown to trigger it.
Indirect evidence suggests the plague described in The Book of Numbers happened in the Spring. /16
As always with my narratives the details are anonymized. Rhabdomyolysis is a condition that exists on a spectrum. I presented a really bad case.
This was inspired by a true story, and a bad “dad joke.”
The following article from 2000 is a great review. jasn.asnjournals.org/content/11/8/1…
This was inspired by a true story, and a bad “dad joke.”
The following article from 2000 is a great review. jasn.asnjournals.org/content/11/8/1…
Also, there are many causes of rhabdomyolysis. It isn’t just over-exertion. There are genetic causes that predispose people to it. Drugs can cause it. Traumatic injuries. Temperature extremes. Toxins. Infections. And more.
As always, Twitter limits my discussion.
As always, Twitter limits my discussion.
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